Speaker 1: Hi, and welcome back to the Karl Marco Show on iHeartRadio.
Speaker 1: I'm going to take a break from monologues for a bit.
Speaker 1: I know people like them and I like doing them,
Speaker 1: but I feel like they're a little disorganized and they're
Speaker 1: just about whatever I'm thinking that day. And I know
Speaker 1: that that is maybe part of their appeal. They're kind
Speaker 1: of spontaneous. It's like I saw this, or I was
Speaker 1: thinking this, or I read this. But I want to
Speaker 1: make them a little more cohesive. I want to jump
Speaker 1: around from topic to topic less and I want to
Speaker 1: have a wider point. I'm almost at the two year
Speaker 1: mark of this podcast, and I've learned a lot since
Speaker 1: I started. I love my listeners and I respect your time,
Speaker 1: so I want to spend this summer figuring out how
Speaker 1: to make the monologues less jumpy and more coherent so
Speaker 1: that my listeners get more out of them. I'd love
Speaker 1: to hear from you all about what you'd like the
Speaker 1: monologues to be going forward, or anything else you'd like
Speaker 1: to tell me at Carol Markowitz Show at gmail dot com.
Speaker 1: I'd love to hear from you. Please let me know
Speaker 1: how your summer's going. Thanks for listening coming up my
Speaker 1: interview with Amy Alkin. But first, folks, we're seeing something
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Speaker 2: Now, welcome back to the Carol Markowitz Show on iHeartRadio.
Speaker 2: My guest today is Amy Alcon, an award winning investigative
Speaker 2: science writer who specializes in science help, using scientific evidence
Speaker 2: to solve real world problems. Amy's new book is called
Speaker 2: Going Menopostal What you and your doctor need to Know
Speaker 2: about the real science of menopause and Perimenopause.
Speaker 3: Hi.
Speaker 2: Amy's so nice to be have you on.
Speaker 3: This is great, Come on, thank you.
Speaker 2: I'm a longtime fan. As you know, I have read
Speaker 2: your previous books. I'm extremely excited to read this one.
Speaker 1: Your new book is a serious look at menopause and
Speaker 1: perimenopause and the way that it's often ignored by doctors
Speaker 1: and researchers.
Speaker 2: So why is that? Is it just sexism?
Speaker 3: No, No, it's not sexism at all. Many of the
Speaker 3: researchers are women. The problem is that, first of all,
Speaker 3: it's there's a whole medicine wide problem that our medicine
Speaker 3: is not really evidence based, and people find this really
Speaker 3: hard to believe. But there are three big myths about
Speaker 3: our medical care. One is that doctors are able to
Speaker 3: read science and make decisions based in science. They're actually
Speaker 3: not taught to read science in med school. Med schools
Speaker 3: and medical institutions are so at fault here. You know,
Speaker 3: people think, oh, you're going to bash doctors. I don't. Actually,
Speaker 3: this is the responsibility of med schools and providers to provide.
Speaker 3: If the doctors aren't trained in science, someone needs to
Speaker 3: be there, you know, nerds to you know, say okay,
Speaker 3: here's what the science says, and to generate practice standards,
Speaker 3: which are the guidelines doctors go by to treat you.
Speaker 3: And then the other the other two myths of that
Speaker 3: doctors are trained in diagnostic reasoning. I'll a doctor house.
Speaker 3: If anyone's seen that show.
Speaker 1: I love it.
Speaker 2: I have never watched it, but I watch them. The
Speaker 2: clips of it now are going viral again for some reason.
Speaker 3: Well, they do this differential diagnosis where they look to
Speaker 3: see what is the underlying condition causing your symptoms and
Speaker 3: what doctors do. This is a big medical error. They
Speaker 3: will treat your symptoms without looking for the underlying disorder.
Speaker 3: So if you have a headache, you know, maybe you
Speaker 3: just are stressed out and you need some whatever tile
Speaker 3: it all, or maybe you have a brain tumor. Now
Speaker 3: if we cure your headache, we've lost an important signal.
Speaker 3: So it's vital that we look for underlying conditions. And
Speaker 3: then the third one is that doctors, this is so horrible.
Speaker 3: They are not trained to correctly assess risk. So they
Speaker 3: can't tell you what's my risk of this or that
Speaker 3: they either will not get it right or they rely
Speaker 3: on these overblown pharmaceutical company rep percentages that are actually
Speaker 3: not meaningful to individuals at all. Their comparisons of one
Speaker 3: group to another. So when they say like fifty percent
Speaker 3: less risk, well that might be you know, it's a
Speaker 3: very small number. You know, it's not your risk, it's
Speaker 3: just this group to the other one. And so these
Speaker 3: are huge problems. And then there's a scandal in gynecology
Speaker 3: that people don't know about. So in gynecology, almost no
Speaker 3: doctors have any training, not even an hour of training
Speaker 3: in menopause or perimenopause science, right because they it's medical education,
Speaker 3: medical education is so terrible. These schools are lazy. There's
Speaker 3: no reason to change them because they're just dodgy bureaucrats
Speaker 3: who run them, you know, taking in the donation dollars,
Speaker 3: and why start these programs in diagnostic reasoning and proper
Speaker 3: risk assessment? These cost money, These require change. New hires
Speaker 3: will just do what we're doing. And this is horrible.
Speaker 3: This is horrible because the father of evidence based medical
Speaker 3: David Sackett, said, fifty percent of what you learn in
Speaker 3: med school will be wrong. The problem is we don't
Speaker 3: know which fifty percent, and it changes. The medicine changes
Speaker 3: so quickly. Now, so doctors. They when you go to
Speaker 3: the doctor, they treat you. They will send you guide
Speaker 3: ecology departments will send you to a baby doctor. Doctors
Speaker 3: who are maternity specialists, and those doctors are made to
Speaker 3: treat you in something they have zero training and expertise.
Speaker 3: And this is medically unethical. This is unethical. They should.
Speaker 3: I write about this in the book by a cardiologist
Speaker 3: I think her name is Sarah Holland she said, you know,
Speaker 3: she's doing these massive cardiovascular operations. And she said, if
Speaker 3: my patient wants me to prescribe allergy medicine. I apologize
Speaker 3: and say, I know it would be more convenient, but
Speaker 3: I don't know that area. She might prescribe the wrong thing.
Speaker 3: And so because of this, doctors, you go to your
Speaker 3: doctor with perimenopausal symptoms, you know, and the doctor doesn't
Speaker 3: know what they are, dismisses you, norse the symptoms, doesn't
Speaker 3: treat you or mistreats you. Doctors will give patience antidepressants.
Speaker 3: This is terrible. I think people have been reading in
Speaker 3: the news. You know, there are great tapering problems for people,
Speaker 3: and what they don't do. They might antidepressants can bring
Speaker 3: down hot flashes, but they don't. They don't solve all
Speaker 3: these problems that you have and unhealth underlying unhealth in perimenopause,
Speaker 3: for example, your bones. They don't protect your bones the
Speaker 3: way our natural hormones do. And what doctors don't know
Speaker 3: the cause of great suffering during perimenopause. And I should
Speaker 3: name some of the symptoms so women get hot flashes.
Speaker 3: This is how I started the book. I was sitting here.
Speaker 3: I live in Venice, California. This is like the most
Speaker 3: temperate place in the world. You know, It's breezy summer day,
Speaker 3: and all of a sudden. I'm sitting here at my
Speaker 3: desk and I'm sure. I'm like, why do I feel
Speaker 3: like I'm locked in a trunk in the everplace? He's crazy?
Speaker 3: I thought, oh my god, I hot flash. And you know,
Speaker 3: you want to go to your doctor and say, I'm uncomfortable.
Speaker 3: What should I do? But I know better. I've been
Speaker 3: coached since around two thousand and seven by this very
Speaker 3: generous epidemiologist and biostatistician, Sander Greenland. He's a co author
Speaker 3: of the seminal book in the field, and he has
Speaker 3: helped me learn how to critically evaluate research and look
Speaker 3: and see if the methodology is adequate. All studies are flawed,
Speaker 3: but are they so flawed that you cannot you know
Speaker 3: that they're not conclusive about anything, and you look for
Speaker 3: a body of work. You don't just go buy one study.
Speaker 3: This is a problem where people say, oh, do your
Speaker 3: own research. Well, you have to know what to look at,
Speaker 3: and you have to look at a great deal of
Speaker 3: research to know you know where, you need to know
Speaker 3: the whole landscape. So all of this is so terrible,
Speaker 3: So you go to your doctor. I oh, so sorry,
Speaker 3: I cut off my story. Basically, I started doing this
Speaker 3: deep dive into the research to figure out what the sciences,
Speaker 3: and I saw this just massive gap between the practice standards.
Speaker 3: These are the standards for treating you, the guidelines for
Speaker 3: treating you that these doctors, I mean, they just read
Speaker 3: them off a list because they don't know themselves, no training,
Speaker 3: and they're victims in this. It is horrible to expect
Speaker 3: a doctor to do this. And this is you know,
Speaker 3: status quo in these departments. So people don't say no,
Speaker 3: they want to keep their jobs. They just get there.
Speaker 3: They're young and new, so they just okay, do the
Speaker 3: best I can. That's horrible. That's horrible, you know, And
Speaker 3: so they don't have any ability to really know what's
Speaker 3: going on with you. And so women are left with
Speaker 3: these symptoms and some of them. One of the things
Speaker 3: I went through a horrible perimenopause. Now perimenopause, I should say,
Speaker 3: is that transition period to menopause, three to ten years
Speaker 3: leading up to menopause, when your hormones start to go
Speaker 3: whack out basically, and what people don't know, what doctors
Speaker 3: don't know, they think that perimenopause is this menopause light
Speaker 3: that your estrogen.
Speaker 1: That's what I really thought it was.
Speaker 3: Yeah, I did too. Believe me, all these things I
Speaker 3: was disabused on when I read the science. What actually
Speaker 3: happens is that your estrogen spikes and dives and this
Speaker 3: causes a release of stress hormones. This is the most
Speaker 3: horrible thing. And then if you don't have the second
Speaker 3: hormone of the menstrual cycle, estrogen's partner, progesterone, being made,
Speaker 3: you can get really sick, which is what happened to me.
Speaker 3: And the reason progesterone is not made in perimenopause is
Speaker 3: that not all of our cycles are ovulatory. This is
Speaker 3: one third throader throughout our lives. And this is all
Speaker 3: the stuff on progesterone and perimenopause comes from the research
Speaker 3: of Geraln. Pryor, who is this fierce woman who grew
Speaker 3: up in Alaska with no running water electricity, daughter of missionaries,
Speaker 3: and brings that fierceness to science. She's an enochronologist and
Speaker 3: has tried to put perimenopause on the map for its
Speaker 3: unique hormonal state, and also have progesterone research, which is
Speaker 3: very important. So progesterone is made when you ovulate, when
Speaker 3: the little eggsaft ruptures and the egg is released. So
Speaker 3: but in perimenopause and then sometimes before you don't have ovulation.
Speaker 3: You know, normal, you have a normal period. It doesn't
Speaker 3: seem any different, but there's no eggsact rupture. And what
Speaker 3: happens that is that you don't have progesterone made because
Speaker 3: it's makes the litter that's left behind called the corpus lute,
Speaker 3: this yellow waxy stuff. And then you have a you
Speaker 3: have days of progesterone, you know where you if you
Speaker 3: have an adequate number where you progest your own you know,
Speaker 3: from the ovulation, then you are protected, your bones are protected,
Speaker 3: You're able to sleep, which I lost. This insomni is
Speaker 3: a huge thing. Yeah, and you're not.
Speaker 2: Insomnia is actually I would say, I'm I'm in my
Speaker 2: late forties. The sleeplessness is the only like symptom that
Speaker 2: I recognize right now. But even going to the doctor
Speaker 2: for that, it's very like, well, you know, maybe wear
Speaker 2: yourself out more, go on more water.
Speaker 1: I'm like, no, no, I have My sleep is not.
Speaker 2: I was an amazing sleeper. I was a champion sleeper,
Speaker 2: and now I've gotten to where, you know, I definitely
Speaker 2: have an issue, and it's it's clearly because I'm heading
Speaker 2: in the minopousal menopausal direction. Like you say, doctors just
Speaker 2: don't know what to do about it.
Speaker 3: So this is what's so important. This is what I
Speaker 3: did with this book, going menapostal. What I do. Medicine
Speaker 3: is not going to change doctors institutions. They are not
Speaker 3: going to be evans based overnight. But we need care
Speaker 3: now that is evidence based. So what I do is
Speaker 3: I bring the evidence to all of us in ordinary language.
Speaker 3: I have right over there on my router. Write every
Speaker 3: page of this book for Pamela d. That is a
Speaker 3: note to myself to not be a jerk or you know,
Speaker 3: write things to show like how smart I am. Right,
Speaker 3: we don't care. Write it in the most accessible, understandable
Speaker 3: language because it's hard stuffed. And I also put in
Speaker 3: all this humor because you cannot read a book like this.
Speaker 3: It's terrifying stuff without having these vacations. Right, and so
Speaker 3: with the sleep thing, what's really important is to do
Speaker 3: this quantitative basil temperature testing. Now people test their more
Speaker 3: first morning temperature to see if they're ovulating. Now, the
Speaker 3: book contains this horrible fact that we do not have
Speaker 3: a twenty day menstrual cycle. This is wrong. Some women
Speaker 3: have much longer ones or shorter ones. And these all
Speaker 3: of these ovulation apps, I mean, they're leading women who
Speaker 3: are expecting to know when they're fertile with the wrong information.
Speaker 3: It's really horrible. But what is effective is measuring your
Speaker 3: first morning temperature through this quantitative basil temperature taking. And
Speaker 3: then what happens is and this is a bit detailed,
Speaker 3: so you can look this up in the book, but
Speaker 3: you want to see if you have enough days where
Speaker 3: you're having progesterone and it's indicated by temperature rise that
Speaker 3: you are protected, that you have this really important protective hormone.
Speaker 3: And because I didn't, and you know, I didn't have
Speaker 3: enough progesterone, I wasn't I wasn't ovulating. My sleep was
Speaker 3: so horrible. I had terrible brain fog. I was waking
Speaker 3: up like you. I mean I never champion. Yes, like
Speaker 3: someone hit me with a large frying pan. And then
Speaker 3: and this was like this, I mean, now I lay
Speaker 3: me down to thrash five or six times a night.
Speaker 3: The torture. I tried every hot, showers, cold, I mean,
Speaker 3: do my feet need to be colder? It was like
Speaker 3: all this voodoo, you know, and so yeah, science in
Speaker 3: this I realized I needed progesterone, and I had to
Speaker 3: fight three battles with TiSER Permanente, my medical provider, to
Speaker 3: get the progesterone, to get the amount I need, which
Speaker 3: they do not give you in America. They don't give
Speaker 3: you an amount protective of the endometrium, which is three
Speaker 3: hundred milligrams of oral micronized progesterone per night, and then
Speaker 3: to get it covered, you know, and I should say
Speaker 3: my ecologist, he was wonderful. I have a male you know,
Speaker 3: not like one of those patients like if you're my cancer,
Speaker 3: if you're my oncologist and you haven't had my lung cancer,
Speaker 3: well I'm not going to go here. He's fantastic, and
Speaker 3: so he treated me with great respect and listen, I
Speaker 3: am an annoying human being. And I threw just a
Speaker 3: mountain of studies at him and then at his boss,
Speaker 3: who was then the head of Kaiser grond Ecology, and
Speaker 3: they actually met with me and listened and were persuaded
Speaker 3: by the evidence I provided, and so they covered the drug,
Speaker 3: gave me the amount I needed, which they'd taken France
Speaker 3: since nineteen eighty safely, you know. And as they said
Speaker 3: to me, well, that's not American you know research. I'm sorry,
Speaker 3: like our French woman in Martians or to think he's
Speaker 3: dressed better and eat better food, you know, I mean,
Speaker 3: it's crazy. So that gave me my sleep. What it
Speaker 3: also does to protect my bones, my cardiovascular system. And
Speaker 3: this is a huge thing I want to mention about menopause.
Speaker 3: We have this fraudulent research that came out around two
Speaker 3: thousand and two, the Women's Health Initiative study that basically said,
Speaker 3: you know, you're gonna get breast cancer your head.
Speaker 2: That's been I mean, I feel like I've read so
Speaker 2: many articles about how that's been disproven and that's just
Speaker 2: no longer considered the case in the medical world.
Speaker 3: It was methodological crap, and it was it was fraud
Speaker 3: basically because these researchers in two thousand and two, I mean,
Speaker 3: if you tell the true story, you know, or if
Speaker 3: you actually first of all do appropriate testing, you don't
Speaker 3: have women scared and you know, throwing their estrogen prescriptions
Speaker 3: in the toilet. What they said is that healthy menopausal
Speaker 3: women will get you know, breast cancer, Alzheimer's, et cetera. Well, wait,
Speaker 3: a second. The women in the study were like seventy
Speaker 3: nine years old, seventy five? You don't give does grandma
Speaker 3: going to the doctorate account of hormones? No? And the
Speaker 3: thing is what we know now, there's something called the timing.
Speaker 3: It's a critical window, the time hypothesis, and it's there's
Speaker 3: good evidence behind this that if you are a healthy
Speaker 3: woman you don't have plaque building up your arteries. You're not.
Speaker 3: You're healthy right at menopause and you start ester. Can
Speaker 3: you initiate it then then it will be health when protective?
Speaker 3: And what doctors said the head of Kaiser, the current
Speaker 3: head of Kaiser Gnecology, this is so appalling. My doctor,
Speaker 3: my excellent gynecologist who listens and considers the science is out,
Speaker 3: you know, and so till August. So I had to
Speaker 3: meet with her. She tells me you need to tape
Speaker 3: her off estrogen at sixty. I said like, oh, this
Speaker 3: is so so outdated and so disproven that even the
Speaker 3: menopause society they're always behind the times. In twenty twenty two,
Speaker 3: my point was like last three weeks ago in twenty
Speaker 3: to twenty two, they came out and there said there
Speaker 3: is no stopping rule. You know, it's to be decided
Speaker 3: on individual health. And the thing is people think, well
Speaker 3: I should get off estrogen. No, if you are, if
Speaker 3: you're healthy, it needs to be you need to be monitored.
Speaker 3: But if you're a healthy person, when you initiate it
Speaker 3: and you remain healthy and your monitor for that, what
Speaker 3: you want is to be taking estrogen when you're old,
Speaker 3: because when do we break bones at seventy nine? And
Speaker 3: we break them because we fall.
Speaker 1: There's stigma around talking about menopause.
Speaker 2: There's nausea, there's bleeding. None of it is very attractive, right,
Speaker 2: But there's also the sense that menopause means you're ancient
Speaker 2: and it's the end of the road. And you kind
Speaker 2: of turn that on its head in the book and
Speaker 2: say that it could be the start of your new
Speaker 2: life or your new path. What do you mean by that?
Speaker 3: Exactly? See, if you have your health, then you can
Speaker 3: just be you all your life and just be a
Speaker 3: little wrinkled, you know, and there are things that go wrong,
Speaker 3: but this is so important. I do not accept the
Speaker 3: stigma that we are less, you know when we age,
Speaker 3: And so I go around telling people, I mean I
Speaker 3: was shove it at them I'm sixty one, I'm sixty one.
Speaker 3: I'm sixty one because.
Speaker 2: I'm very I'm forty eight and I'm open about it
Speaker 2: and I don't care, and I'm never gonna lie about
Speaker 2: my age.
Speaker 3: And the thing is, I'm a better human being in
Speaker 3: every way, you know, except for my eyesight. Now it's
Speaker 3: sixty one than I ever was. I'm kinder, you know,
Speaker 3: my work is better. It's just wonderful to be this
Speaker 3: age and be the person I am now. And I
Speaker 3: see those so many women. Something happens at fifty women
Speaker 3: we have we tend to be, many of us timid
Speaker 3: in some ways, you know, And at fifty, so many
Speaker 3: women developed this confidence almost out of nowhere, where they
Speaker 3: will speak up, you know, pitch themselves, put themselves out there,
Speaker 3: stand up for things. And this is exciting, and you
Speaker 3: can even if that's not naturally occurring for you. The
Speaker 3: thing is, you know, our emotions and our way of being.
Speaker 3: This is not a mandate. You can choose to be
Speaker 3: that way, and you can choose to be this about
Speaker 3: age also to be this way. And the reason that
Speaker 3: it's it's important to do this is that we can
Speaker 3: have a whole like third or fourth act. And so
Speaker 3: my friend I'll give my friend w Levin as an example.
Speaker 3: She I met at the Alternative Weekly newspaper conferences. I
Speaker 3: was selling my syndicated column. She was selling John Callahan,
Speaker 3: the cartoonist, and she was She's an agent. She's really
Speaker 3: great at that. Well. She is now a pretty legendary ceramicist.
Speaker 3: She sells her work all over galleries, you know, the
Speaker 3: like designers. It's really sought after. And this just happened
Speaker 3: in a few years and she developed this and this
Speaker 3: is the way. And like a neighbor of mine, missus
Speaker 3: Abbot Kinney, she used to be on Twitter. She does
Speaker 3: literacy volunteering for adults, teaching adults to read at our
Speaker 3: library here in Venice. So you can volunteer, you can
Speaker 3: move to Portugal. You know, there's some of it you
Speaker 3: can do and you just have to decide. You know
Speaker 3: that that really I call it old is the new black.
Speaker 3: I'm old. I'm old. I say it. I'm old, and
Speaker 3: I'm fabulous. You know the thing you're old? Yes I am,
Speaker 3: I am.
Speaker 2: It gets me into my my one of my three
Speaker 2: questions that I ask all my guests, what do you
Speaker 2: worry about?
Speaker 3: Oh? My god? I worry that I've missed something, that
Speaker 3: I'm not getting the science right. I have such a
Speaker 3: responsibility to people, and so luckily this worry and the
Speaker 3: lack of you know, the sort of arrogance that comes
Speaker 3: with being formally educated, you know, has me looking at
Speaker 3: things and relooking at things and sending my workout to
Speaker 3: be fact checked. I tell people actually to like kick
Speaker 3: my ass, wipe the floor with me, because they don't
Speaker 3: believe you when you say you want criticism. But that's
Speaker 3: really important to me, and that is my terror.
Speaker 2: I love that we're going to take a quick break
Speaker 2: and be right back on the Carol Marcowitch Show. What
Speaker 2: advice would you give your sixteen year old self? Like,
Speaker 2: what did sixteen year old Amy not know that you
Speaker 2: wish she did.
Speaker 3: Respect is not conditional on other people's behavior. I had
Speaker 3: no friends until I was fifteen, and you become sort
Speaker 3: of suck up. And the thing is you are not going,
Speaker 3: first of all, not going to get them to be
Speaker 3: your friends or like you if you behave without self respect,
Speaker 3: if you're you know, sucking up and trying to you know,
Speaker 3: trying to get people like you. And so the best
Speaker 3: thing is to just be you, proud you, not suck up,
Speaker 3: you know, not let it ever be relative.
Speaker 1: I love it.
Speaker 2: I can't imagine you ever being a suck up. Honestly,
Speaker 2: you're so independent and outspoken. I just feel like you're
Speaker 2: I've never thought, oh, Amy doesn't say what she thinks.
Speaker 3: No, but this is the thing we can all change,
Speaker 3: you know. I talked in the book about choosing resilience.
Speaker 3: You know, we have a lot of stuff go wrong
Speaker 3: with us, you know, and you can choose to have
Speaker 3: that attitude. I have this beautiful quote, I'm not going
Speaker 3: to remember it, but my friend Leslie Gray Streeter talks
Speaker 3: about I'm the child of Jim Crow, her husband who's widowed.
Speaker 3: They had just adopted a baby, all of this, but
Speaker 3: she said, I choose joy, you know, and it makes
Speaker 3: me cheer up each time. And that's the way you can.
Speaker 3: You can choose to have that attitude. And I think
Speaker 3: that it's really important to do that to understand that.
Speaker 1: I love it. Well. I've loved this conversation.
Speaker 2: I can't wait to read. Going menipostal end us here
Speaker 2: with your best tip for my listeners on how they
Speaker 2: can improve their lives.
Speaker 3: If you if you live to be healthy if you
Speaker 3: do this, if you do weight bearing exercise, slow speed
Speaker 3: strength training, and you'll eat a very low carb or
Speaker 3: cardboard diet. These are the two things you need to
Speaker 3: be healthy throughout your lifespan. And this is the most
Speaker 3: These are the two most important tips I can give you.
Speaker 2: I love that so much. Thank you so much for
Speaker 2: coming on Amy. Check out her new book Going Menipostal,
Speaker 2: What you and your doctor need to know about the
Speaker 2: real science of menopause and perimenopause. Thank you so much, Amy.
Speaker 1: Thanks so much for joining us on the Carol Marco
Speaker 1: which show. Subscribe wherever you get your podcasts.